Costs are spiraling out of control, access is declining, and our quality of care doesn't match what other developed nations are delivering at half the cost. In the search to reduce costs and bring our ever inflating health care budget under control, the powers that be (insurers, government, health policy wonks (and maybe a few doctors) have looked to individuals with less formal education to perform medical services that were once ...

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I gently rotated his arm as the beads of sweat formed on his forehead.  The pain came in waves.  His face contorted and relaxed in repetitive spasms.  I wondered if my exam was in vain.  The cancer had spread from his lungs to his liver and into his bones.  Once the blood stream had been tainted, the aggressive cells took flight and landed in various organ systems. We already had the conversation.  I ...

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The circle of support in the critical moments of the cancer journeyOn a recent trip to Philadelphia, I caught up with Dan, a friend of mine since college. He is an artist in Philly, where he lives with his wife and daughter. He had asked me about being an oncologist, told me he had read my ASCO blogs. We spent hours discussing everything—parenthood, careers, and mutual friends, and one in particular. Her ...

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If you have been in practice for more than 10 years, you are probably familiar with the concept of professional courtesy where doctors treat their colleagues without charging them.  With reimbursement decreasing and overhead expenses rising, many physicians have started charging their colleagues when they provide their fellow colleagues with medical services. What is the position of the AMA?  The AMA advises that physicians should be aware that forgiveness or waiver ...

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I am a patient. Yes, and a physician; a brother, father, husband, grandfather, uncle, friend, neighbor, taxpayer and concerned citizen. What healthcare reform means to you means the same to me, or more. Maybe because as a physician I focus on it a little more than the average person, I have an additional responsibility to share my perspectives? Maybe a little knowledge is a dangerous thing, as the saying goes. I ...

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A few days ago, I came across an article entitled “Calling Dr. Google” by Jeff Jarvis. The writer describes his experience “Googling” his symptoms and finding that the internet brought him the correct diagnosis. He uses his personal story of appendicitis to point out that physician fear of information on the internet is overblown. One would hope that the argument that you cannot find any trustworthy information on the web ...

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When we love someone, we want for them the best.  We fight for and with them.  We push them to attack disease.  Is it possible that our very love can cause suffering?   Can we mistake our eternal love for each other with a futile fight for immortality?  Does our caring crush the ones for whom we care? In a fascinating article, the Wall Street Journal followed the terminal case of ...

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Most of us will not have the opportunity to just die of “old age” or to simply fall to sleep one night never to wake again. Most often, we develop an illness which causes our death. These have changed markedly over the years. For the pioneers, accidents, infections, childbirth were times and causes of great likelihood of death. A century ago, infections were the leading causes of death. Today, we ...

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When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that ...

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Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation). I would never go to a non-board ...

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